<div class=grid_18>
<div class=grid_10> 
    <div class=block-border> 
        <div class=block-header> 
            <h1><span>SDA Church - Kwabrafoso: Enter A New Town</h1></span> 
        </div> 

        <form id=validate-form class="block-content form" action="add" method=post>

            <div class=_50> 
                <p><label for=stextarea>Division Name</label> 
                    <input id="divname" name="divname" class="required" class="input-xlarge" type="text" value=""/></p> 
            </div>

            <div class=_50> 
                <p><label for=stextarea>Union Name</label> 
                    <input id="uniname" name="uniname" class="required" class="input-xlarge" type="text" value=""/></p> 
            </div> 

            <div class=_50> 
                <p><label for=stextarea>Conference / Mission Name</label> 
                    <input id="conname" name="conname" class="required" class="input-xlarge" type="text" value=""/></p> 
            </div> 

            <div class=_50> 
                <p><label for=stextarea>Region Name</label> 
                    <input id="regname" name="regname" class="required" class="input-xlarge" type="text" value=""/></p> 
            </div>

            <div class=_50> 
                <p><label for=stextarea>District Name</label> 
                    <input id="distname" name="distname" class="required" class="input-xlarge" type="text" value=""/></p> 
            </div>

            <div class=_50> 
                <p><label for=stextarea>Town Name</label> 
                    <input id="townname" name="townname" class="required" class="input-xlarge" type="text" value=""/></p> 
            </div>
                
            <div class=block-actions> 
                <ul class=actions-left> 
                    <li><a class="button red" id=reset-validate-form href="javascript:void(0);">Reset</a></li> 
                </ul> 
                <ul class=actions-right> 
                    <li><input type=submit id="Save-Town" class="button" value="Save Record"></li> 
                </ul> 
            </div> 
        </form> 
    </div> 
</div> 